A Physio’s 5 Key Rules For Dealing With Back Pain


Back pain, hellish back pain. According to the World Health Organisation, it affected 619 million people around the world in 2020, with that number predicted to rise to 843 million by 2050. If you’ve succumbed to it yourself, you’ll know it’s the kind of silent paint that can impact every moment of your day. Complaining about having a “bad back” might seem like par for the course after a certain age, but what exactly can we do to tackle it?

What are the common causes of back pain?

“Back pain can stem from various factors, including bio-mechanical and lifestyle choices,” explains Florence Penny, a consultant musculoskeletal physiotherapist and the founder of Flow Physio London. “More often than not, back pain is caused by a strain or pain in the muscles and ligaments in the lower back, either due to overactivity or poor form in the gym. Or, muscle imbalances associated with desk work and reduced movement throughout the day.”

The lower back, she says, is a matrix of interconnecting bones, joints, nerves, ligaments and muscles, all of which work together to provide support and mobility. But, due to their complexity, it is an area susceptible to injury and pain. So if you’re a gym bunny, incorrect or forceful movements that strain the muscle’s capacity may be to blame. If you’re someone with poor posture who sits curved like a shrimp (you’ve seen the meme) in a chair that’s not fit for purpose at work all day, that could be behind your back pain.

Weak core muscles are also common culprits. When our core is weak, it is often the “result of a sedentary lifestyle, lack of exercise, improper workout techniques, or sticking to the same exercise routine without diversity”, says Penny. “An exercise programme needs to be diversified regularly to continue to challenge the body.” She notes that most of us tend to avoid doing exercises that we find difficult, but actually it’s exactly those types of movement that we should be focusing on. If you find a move tricky, chances are you need to be doing more of it.

Other causes include age-related changes, such as reduced muscle mass and decreased bone density, with the effect being more pronounced in women due to declining oestrogen levels during the perimenopause. Not to mention emotional stress, anxiety and depression, all of which “can contribute to muscle tension, altered pain perception and ineffective coping mechanisms, which can worsen or lead to back pain”.

How to deal with back pain

When lower back pain spasms strike and it’s difficult to move, Penny has a three-step method you should try:

  1. Control your breath. Slowly breathe into your lower abdominals and lower back, and try and calm yourself.
  2. Explore movement. Work into the areas that feel easier. Try to complete a pelvic tilt [a subtle move, where you pull your pelvis forward] and use your arms to help support movements that are painful. Do not push into pain, but try to keep moving with small rest breaks.
  3. Ice. Utilise ice in this initial period as a method of pain relief. It’s also always important to note here that pain does not reflect the level of damage – especially in the first 48 hours – so just try and keep yourself as calm as possible.

Thereafter, it’s all about exercise, which is the “only current approach that can prevent recurrence of lower back pain”, says Penny. “Some movements may need to be temporarily avoided in order to decrease pain, but eventually we need to reload affected areas and build tolerance.” Core training is an effective way of doing this.

There’s a reason why people rave about the benefits of Pilates for a bad back. Somatic movement like this helps increase conscious body awareness while also developing strength and flexibility. Not to mention, it creates a strong core, glutes and back extensors, all of which contributes to a healthy back whilst helping to relax tight hips.

Penny recommends focusing on micro commitments to make rehabilitation seem less intense, and remembering that one size does not fit all: “It’s important to focus on yourself and understand that we are all individual in our genetic make-up,” she says. “But generally, it’s also worth focusing on improving your sleep quality and learning how to breathe properly.”

It’s worth investing in a foam roller and making it a daily practice. “Foam rollers can be effective at helping to improve mobility,” she says. “Most research shows that they don’t create physical change, but do encourage tight muscles to relax by calming the nervous system.”

If you’re suffering from persistent back pain, it’s always worth going to see a physiotherapist who can help identify the source and the structures within the body that are involved in causing the back pain, and then create a management plan, featuring specific exercises. “They will also help you to learn about what’s causing the issue, which can help prevent it in future, and can offer soft tissue techniques – a combination of massage, soft tissue release or mobilisations which can help reduce pain, take load off the injured area and improve range of motion,” adds Penny.

If you do nothing else…

Incorporate regular movement into your day

“It’s important to combat prolonged sitting with regular movement. Consider a standing desk, integrate a gentle stretching routine into your daily habits, take breaks and move regularly. Counteract the effects of a sedentary lifestyle, which can lead to increased stiffness, by prioritising physical activity and exercise.”

Look at your movement routine

“Address issues arising from repetitive movements or improper heavy lifting by diversifying your routine. Adopt a comprehensive approach that encompasses various activities that sit into the three core pillars: strength, stability and flexibility. For example, if you primarily engage in strength training, consider incorporating elements of control work and explore complementary practices like Pilates or Barre.”

This article was originally published on British Vogue.

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